Friday, 8 March 2013

Spare parts

I use(d) my blogs (both past and present) for different reasons. Sometimes to grumble, sometimes to express worry, sometimes to celebrate, sometimes to ask for advice, and so on. Sometimes however I like to think of this blog like a couch in a posh psychiatrist's office. By that, I don't mean that I secretly feel the need to see a shrink, but rather that it's occasionally nice to have a blank, neutral space to express thoughts which I wouldn't share with other people. Other people tend to fall into specific categories whom I can't, or don't, necessarily want to speak to about certain things. More on this in a minute.

Since I'm still a pre-clinical student, I haven't yet been exposed to much of the emotional side of medicine: the dead/dying patients, the sorrowful relatives, the aftermath of a failed resuscitation attempt, etc. These are largely things I've read about, heard about or watched on TV. I've also never seen a fresh dead body before. I've seen prosections (professionally dissected and preserved body parts) before in my previous degree, but never the body of a recently deceased person. I'm not afraid of the notion of death or mortality, like many I consider death to (paradoxically) be just another part of life, and since I don't believe in an afterlife I also think it's more important to enjoy life whilst I'm living, rather than constantly worry about the inevitable. So this post isn't about fear of death or anything like that.

Normally our anatomy sessions make use of prosections. The thing with prosections is that they're very professionally prepared and preserved. So much so that in my opinion, they no longer resemble a human body part. They look more like a really realistic model. They don't feel very lifelike and they're not easily manipulated (the fingers feel stiff, etc) That makes learning from them easier and also means there's no emotional involvement. After all, you can't get contemplative over what only looks like a very hi-tech model.

This week however, there was a slight change to our anatomy schedule: we would not be using the professional, preserved models, but rather fresh specimens from a cadaver. This was a pretty educational experience for me in many ways. For a start, it made me immediately realise how little anatomy teaching has evolved over the centuries at its basics:

Aside from some very obvious and positive differences between the 17th and 21st centuries (female students/demonstrators, no longer abusing the bodies of dead convicts, no ruffs, etc), Rembrandt's painting is remarkably similar to what I experienced in the anatomy lab this week, right down to the dissection of the upper limb and the pulling of various tendons to cause flexion of dead fingers. In some ways, the continuity of medicine and human anatomy is comforting, in that hundreds of thousands of students before me have gone through it all and will know what I'm talking about, but I do think it's still a very unique experience and each student will have different thoughts at the time. Some students treated the session like a museum exhibition, some treated it like a science experiment, others seemed in deeper thought. Some were just too tired out after a very long week and the shadow of revision looming in the distance to particularly care either way. I don't think there are any rights or wrongs, I'm just here to talk about my own thoughts.

Personally, I was just surprised at how lifelike the dead specimen still looked. Right down to the hairs (still very long and visible) on the arm, the tattoos, and the softness of the skin (even through gloves this was obvious). Sure there were blemishes and discolourations, but on the whole there was no confusing this for a hi-tech model. It was very much a human specimen, right down to the still very present fingernails (the fingernails on preserved prosections tend to wither to a hard yellow plate at tip of each finger - hardly realistic). The finger nails, and indeed, remnants of fingerprints on this dissected arm were unmistakeable however. There is a train of thought which can follow on from these observations. Fingerprints are unique to each person, so noticing them almost immediately makes you conclude that this specimen is definitely real and not just a "thing". Once you consider that this is real, you also consider that it had a life too. Putting the rest of the pieces of this puzzle together isn't particularly difficult.

This is what I meant by things I "can't or don't want to" speak with other people about. Many non-medics (so my siblings, parents, non-medic friends, etc) are pretty squeamish. Talking at length about my thoughts before and after seeing dead human tissue is not something I feel is fair on them. There are friends in my class and other medics I could talk to I guess and, but for some reason something is stopping me doing this too - I'm not sure what either, since I normally have no problems talking about different things to do with the course. But at any rate, that's why I've ended up on here.

Long story short, these realisations made it somewhat harder to concentrate purely on the anatomical science. Sure, I listened to what the demonstrator had to say, I pulled on the tendons, inserted my fingers into various anatomical points of interest, and yes, I learned a lot too - viewing forearm pronation/supination and how the radius pivots about the ulna was much more easily appreciated in this specimen rather than a hard immobilised specimen. I saw that a much greater quantity of fat is located under the skin than I previously thought and how much thicker the nerves are. On the whole however, I think I was more contemplative during the session than I normally would have been. I didn't feel sick, faint or like passing out...but I didn't feel like I was just taking part in a purely academic exercise either, which is normally how I feel when in the anatomy lab, with the usual specimens. I'm sure some of Dr Tulp's students might have felt this way too. Or maybe not, who knows? I personally don't feel like I'm the only one who must be thinking this though.

At some point over the next few weeks, I also have to observe a post-mortem examination as part of my pathology module. Now that I've had (some) experience of fresh cadavers, I think I know what to expect...but much like today's experience, I don't think it'll be a purely academic experience for me. Maybe this sort of thing becomes less remarkable with time as you become desensitised to it, but for now, I felt like it was an important part of my medical training which I should reflect on.

Oh, and another thought which randomly occurred to me today - exactly a year has passed since I got into medical school. Today's post really sums up, I think, just how far I've come since then, in so many different ways. But one thing's for certain, re-reading my acceptance letter earlier today, I'm extremely happy to be on this path. Wonder what I'll be doing this time next year!